ICN urges South Korea to make the right choice and back the Nursing Act
Nurses in South Korea have undertaken a long campaign for a new law to establish nursing as a stand-alone profession, but their government has not enacted the so-called Nursing Act, which means nursing is still considered to be subordinate to physicians only able to act as assistants rather than as autonomous health professionals.
The decision not to pass a Nursing Act, which is the foundation of Advanced Practice Nursing, undermines the professional development of nurses, limiting options for improving access to health care services.
The introduction of a new cadre of nurses called ‘Physician Assistant (PA) Nurse’, as a response to worsening shortages of physicians, weakens and confuses well established globally recognised Advanced Practice Nursing roles.
Physician Assistants are recognised in many different countries as clinicians who work under the direct supervision of physicians. They are separate to nursing and by definition are completely different roles. Joining two distinct professional groups into a combined role is counterproductive to international best practice.
A well established and internationally recognised option to improving access to quality health care in the presence of physician workforce shortages is the investment in nurses working to their full scope of practice. In particular, creating environments in which nurses can continue their professional career into Advanced Practice Nursing roles is optimal.
The evidence clearly supports the effectiveness of advanced practice nursing as an effective strategy for health systems responding to rising costs, increased healthcare demands and the desire to place people at the centre of care. In the ICN Guidelines on Advanced Practice Nursing, ICN has clearly articulated its position that the way forward is to implement proven, standardised, well established APN roles, rather than developing a new cadre of nurses.
ICN has previously warned that some countries have responded to nursing shortages by making these kind of ill-advised choices and creating new cadres of health care workers rather than investing in nurses. The evidence clearly supports the effectiveness of advanced nurse roles, and that is the right choice for health systems looking to respond to rising healthcare demands and delivering people-centred services.
Commenting on the situation in an interview with the South Korean weekly journal Sisa ICN Chief Executive Officer Howard Catton said: “The South Korean government could so easily be making the right choice and a better decision if they implement advanced practice nursing roles and legislate a Nursing Act. There is huge untapped potential here.”
Mr Catton went on to say, “it is erroneous to use the terms ‘nurse’ and ‘PA nurse’ interchangeably. A ‘PA Nurse’ is no substitute for either a Registered Nurse or Advanced Practice Nurse, and such roles can create safety risks for both patients and the practitioner, and ultimately be more costly.
‘ICN defines nurses as healthcare professionals who work autonomously and collaboratively in a variety of health care settings with many different roles and responsibilities. The strength of healthcare systems worldwide relies on the foundation of qualified nurses.”
In South Korea there appears to be ambiguity about the roles nurses can undertake. By law they are supposed to only act under supervision from physicians, dentists and acupuncturists. In most countries, the scope of nursing practice encompasses more than specific tasks or responsibilities; it is a blend of knowledge, judgment, and experience. This allows nurses to provide direct patient care, evaluate its impact, advocate for patients, supervise and delegate responsibilities, lead, manage, teach, conduct research, and develop health policy. The dynamic nature of healthcare requires that the scope of practice be regularly reviewed to remain aligned with current health needs and technological advancements.
ICN strongly advocates for nurses to work to their ‘full scope of practice’. This means that nurses fulfil the spectrum of roles, functions, responsibilities, activities and decision-making capacity that they are educated, competent and authorized to perform. The full scope of practice needs to be supported by both professional standards and legislation.
Mr Catton said, “If a nurse is forced to do something outside of their scope of practice without proper authorization or education, and a patient safety incident occurs, the nurse may be held liable, even if the health system had required them to do so."
South Korea's enactment of the Nursing Act would bring it into line with international practice and would strengthen the nursing profession. ICN recommends the enactment of a nursing law to achieve role clarity for nurses.
The Case for Advanced Practice Nursing
- APNs, including nurse practitioners, have proven to be safe, improve health outcomes, provide cost-effective care, and enhance both provider and patient experiences. Recognizing and supporting APNs in South Korea would align the country with international standards and make better use of the existing potential within the health care system.
- APNs strengthen the entire nursing workforce by offering clear career pathways and improving foundational education. This professional uplift not only enhances the quality of nursing care, it also ensures that nursing remains an autonomous profession, distinct from but complementary to medicine.
- The recognition and support of APN roles are crucial in looking toward the future. They ensure the sustainability of the nursing workforce by improving nursing retention and positioning nursing as a career of choice. As South Korea considers its health care policies, recognizing the value of APNs would be a significant step toward resolving current challenges and aligning with global best practices.